Cor Vasa 2002, 43(3):154-158

A comparison of ultrasound findings of hemodynamically significant dialysis vascular access stenoses with angiography

Jan Malík^1,*, Marcela Slavíková², Jana Mašková³, Jaromír Hradec¹

¹ III. interní klinika

² II. chirurgická klinika - kardiovaskulární chirurgie

³ Radiodiagnostická klinika, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Introduction:
Early diagnosis of hemodialysis vascular access stenosis is important for maintaining long-term shunt patency and function. Ultrasound is a non-invasive alternative to angiography in diagnosing stenoses. The aim of the study was to establish the sensitivity and specificity of ultrasound-based diagnosis of hemodynamically significant stenoses compared with digital subtraction angiography (DSA) as the gold standard.

Patients and methods:
The ultrasound and DSA findings in 49 patients were compared. The vascular bed of the afferent artery and efferent vein was divided into 7 segments with native shunts, and into 6 segments with vascular prostheses. The ultrasound criterion of significance was a combination of at least 50% stenosis in B-mode, and at least a double increase in flow rates in systole compared with an uninvolved segment.

Results:
Ultrasound-based diagnosis of dialysis shunt stenoses reached an 85% sensitivity, and a 94% specificity; with a positive predictive accuracy of 89% and a negative predictive accuracy of 92%. False negative ultrasound findings were noted mainly with central vein stenoses, while false positive findings were reported particularly with arterial anastomosis.

Conclusions:
Compared with DSA as the gold standard, findings of hemodynamically significant dialysis vascular shunt stenoses, as established by duplex Doppler ultrasonography, are highly reliable.

Keywords: Arteriovenous shunt; Hemodialysis; Duplex Doppler ultrasound; Angiography

Published: March 1, 2002  Show citation